How do you resolve conflicts between global surgical packages and additional procedures?

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To resolve conflicts between global surgical packages and additional procedures, it's essential to understand how the global period works and when exceptions apply.

What is a Global Surgical Package?

A global package includes:

• Preoperative care (1 day before surgery)

• Intraoperative care (the procedure itself)

• Postoperative care (typically 10 or 90 days, depending on the procedure)

Conflicts arise when:

• Additional procedures are billed during the global period.

• There’s uncertainty about whether the new service is included or separate.

Steps to Resolve Conflicts:

1. Check Procedure Codes and Global Days
   Determine if the additional procedure has a 0-, 10-, or 90-day global period and whether it overlaps with the existing surgery.

2. Use Modifiers Correctly

   • Modifier 24: For unrelated E/M services during the post-op period.

   • Modifier 25: For significant, separately identifiable E/M on the same day as a procedure.

   • Modifier 58: For a staged or related procedure during the post-op period.

   • Modifier 78: For unplanned returns to the OR for related procedures.

   • Modifier 79: For unrelated procedures during the post-op period.

3. Document Thoroughly
   Documentation should clearly support why the additional procedure is separate—different condition, location, or purpose.

4. Refer to Payer Guidelines
   Some insurers have specific rules or bundled payment edits (like NCCI edits). Always verify their policies.

Summary:

To avoid denials, use correct modifiers, ensure clear documentation, and always check payer-specific rules. Proper coding distinguishes between related and unrelated services, ensuring accurate reimbursement.

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